title: [Diabetes of type 1, pregnancy and glycemic control].
abstract: Type 1 diabetes has wide-ranging effects for expectant mothers and their unborn children. Optimal blood sugar control minimizes complications for both. We assessed maternal and neonatal outcome in relation to glycemic control.
  
  
  
  Retrospective evaluation of pregnancies among type 1 diabetic women in Iceland during 1999-2010, with information collected from maternity and newborn records on disease severity, HbA1c values before and during pregnancy, delivery mode and complications.
  
  
  
  There were 93 pregnancies among 68 women (47% primigravid). Mean age was 29 years and mean time from diabetes diagnosis 16 years (median 19, range <1-35 years). Retinal changes affected 57%, chronic hypertension and thyroid disease 13%, kidney disease and neuropathy <10%. Mean HbA1c before pregnancy was 7.8% declining to 7.5% in first and 6.3% by third trimester. Women <25 had worse first trimester blood sugar control compared to those 25-35 (p<0.04) and >35 years (p=0.02). Delivery was induced in 40% and the cesarean section rate was 65%. Mean gestation was 37+2 weeks. There were two stillbirths. Preterm deliveries were 28%. Congenital anomalies affected 9% of newborns (mostly cardiac). One-third of newborns developed diabetic fetopathy, one-quarter jaundice, both associated with worse maternal bloodsugars.
  
  
  
  Most women with type 1 diabetes improved blood sugar control during pregnancy, which became good or acceptable by the last trimester by HbA1c values. Cesarean section was over three times more frequent than in the general population. Neonatal complications and congenital anomalies were also more common. To minimize complications improved control of bloodsugar is needed before and throughout pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Clinic, Landspitali University Hospital, Hringbraut, 101 Reykjavik. reynirg@landspitali.is
authors.forename: Sigrídur Sunna
authors.initials: SS
authors.lastname: Gunnarsdóttir
authors.forename: Arna
authors.initials: A
authors.lastname: Guðmundsdóttir
authors.forename: Hildur
authors.initials: H
authors.lastname: Hardardottir
authors.forename: Reynir Tomas
authors.initials: RT
authors.lastname: Geirsson
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D002585:Cesarean Section; D048909:Diabetes Complications / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007055:Iceland; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011254:Pregnancy in Diabetics; D011297:Prenatal Exposure Delayed Effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human